What do women want? Safety and choice in healthcare

The answer to the seemingly difficult question 'what do women want?' is not so elusive after all.

When it comes to their health, particularly when pregnant, women want to be close to home, have continuity of care, collaboration with carers and the ability to make informed choices.

National Rural Health Commissioner Ruth Stewart says despite those health priorities being outlined to state and federal governments in a 2018 survey, rural women still don't receive that level of care.

"Continuity of care and carer is rarely provided," Professor Stewart told the Royal Australian and New Zealand College of Obstetricians and Gynaecologists rural women's health roundtable in Melbourne on Tuesday.

"If you don't have choice between different models of care you really can't make a choice.

"If there's no choice you can't be informed so anything about collaborative decision-making is irrelevant. 

"We certainly struggle to provide care close to home for many rural and remote Australian women."

Initial results of a mapping project showed availability of surgical abortion was limited in rural areas, while access to medical abortion was scarce in remote locations.

Obstetrician and gynaecologist Jared Watts, the project's lead investigator, said those statistics could give insight into the effects on people seeking abortions.

"Is this an actual problem to people: (do they) not go ahead with their choice because it is too hard?" Dr Watts said.

There was also limited access to specialist services including key hole hysterectomy surgeries and endometriosis care.

But in rural areas where there was 24-hour obstetric care, the demand was increasing.

"Many of our patients want to be closer to home, so how should we be designing our obstetric services in the future?"

The roundtable heard the ageing specialist workforce was largely city-based and there was limited access to upskilling and training in rural areas.

Sam Newbury, an obstetrician and gynaecologist and the college's Victorian committee chair, said doctors needed support in rural communities.

"There has to be something to come to. There has to be job satisfaction, you have to be part of the community, you have to be appreciated," Dr Newbury said.

"There's lots of hurdles for people when they try and make that decision: there's no childcare, you can't get a house for rent."

But rural health professionals also needed to change the narrative about working in country areas, he said.

"Because it is pretty desperate, when people come that's what they feel: they feel desperation, they feel overworked, they feel like they're trying to fill a gap. 

"So (we need to) try to maintain that positive culture ... and maintain the positive aspects of what it is to do the job and reflect on the good work. 

"No one's going to jump onto a sinking ship."